Pennsylvania Workers’ Comp Claim Pricing Solutions

OVERVIEW

In Pennsylvania, calculating workers’ compensation claim payments is extremely complex. Insurance companies can take advantage of these complexities when they compute payments, which are often less than what is due to the hospital. Worse, if you believe you have been underpaid, you have only thirty days to file a formal appeal. After the thirty-day deadline has passed, there is little or no chance of collecting any additional dollars.

When discrepancies arise, our claim pricing service takes the guesswork out of this process and provides hospital clients with the information needed to make informed arguments with PA workers’ compensation insurance companies and to file Applications for Fee Reviews with the PA Bureau of Workers’ Compensation. Your staff will be able to respond more quickly, and more accurately. Typically, this results in reduced staff time, increased revenue capture, and accelerated cash collections.

KEY BENEFITS

Our service lets you evaluate payments from PA workers’ compensation insurers quickly and accurately so that the correct expected reimbursements can be compared to the actual insurance payments. To fit your operation best, we provide reports weekly, bi-weekly or monthly. When you know the correct amount to expect on each claim, you can react immediately every time there are variances between the correct payment and the actual amount you receive.

WHY IS THIS THE BEST SOLUTION?

Typically, we compete with hospital contract management systems that are commonly used to calculate expected payments internally. But since PA workers’ compensation is so specialized, most of these internal systems don’t have the resources to achieve accurate expected amounts. Our solution is an affordable alternative to these managed care systems.

WHAT OUR CLIENTS SAY

Time and time again, our clients have thanked them for replacing guesswork with precision and certainty.

PART OF AN EVEN LARGER SOLUTION

SunStone’s PA workers’ compensation CDM update service is an essential complement to our claim pricing service. The CDM-based fee schedule and all quarterly CDM updates are used by all PA workers’ compensation insurers to compute payments for outpatient hospital claims. By submitting CDM updates on a regular basis, you strengthen your ability to collect the correct PA workers’ compensation reimbursement amounts.